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In my personal style of practice so far, I've found myself to be extremely reluctant to prescribe opioids in the outpatient setting. In the hospital, sure, if it's needed. But in the clinic? It seems like my mindset has been molded from day 1 to almost never prescribe them.
But then there are chronic pain patients who have objective imaging findings that correlate with their pain. They're on every lyrica, nsaid/tylenol, duloxetine and whatever cocktail you can think of and have done PT among other things without much relief. What's the threshold for starting opioids on such patients? They definitely suffer and it reaches a point where I have nothing else to offer. And certainly many of these patients take advantage of the euphoria of these drugs (I'm not naive to that) but where do we draw the threshold?
But then there are chronic pain patients who have objective imaging findings that correlate with their pain. They're on every lyrica, nsaid/tylenol, duloxetine and whatever cocktail you can think of and have done PT among other things without much relief. What's the threshold for starting opioids on such patients? They definitely suffer and it reaches a point where I have nothing else to offer. And certainly many of these patients take advantage of the euphoria of these drugs (I'm not naive to that) but where do we draw the threshold?